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Open Access

Fatal respiratory diphtheria in a visitor to Canada

Scott Cholewa, Fareen Karachiwalla, Sarah E. Wilson, Jeya Nadarajah and Julianne V. Kus
CMAJ January 04, 2021 193 (1) E19-E22; DOI: https://doi.org/10.1503/cmaj.200707
Scott Cholewa
Public Health Branch (Cholewa, Karachiwalla), Regional Municipality of York, Newmarket, Ont.; Dalla Lana School of Public Health (Karachiwalla, Wilson), and Faculty of Medicine (Nadarajah), and Department of Laboratory Medicine and Pathobiology (Kus), University of Toronto; Public Health Ontario (Wilson, Kus), Toronto, Ont.; Department of Family Medicine, School of Medicine (Karachiwalla), Queen’s University, Kingston, Ont.; Institute for Clinical Evaluative Studies, (Wilson), Toronto, Ont.
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Fareen Karachiwalla
Public Health Branch (Cholewa, Karachiwalla), Regional Municipality of York, Newmarket, Ont.; Dalla Lana School of Public Health (Karachiwalla, Wilson), and Faculty of Medicine (Nadarajah), and Department of Laboratory Medicine and Pathobiology (Kus), University of Toronto; Public Health Ontario (Wilson, Kus), Toronto, Ont.; Department of Family Medicine, School of Medicine (Karachiwalla), Queen’s University, Kingston, Ont.; Institute for Clinical Evaluative Studies, (Wilson), Toronto, Ont.
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Sarah E. Wilson
Public Health Branch (Cholewa, Karachiwalla), Regional Municipality of York, Newmarket, Ont.; Dalla Lana School of Public Health (Karachiwalla, Wilson), and Faculty of Medicine (Nadarajah), and Department of Laboratory Medicine and Pathobiology (Kus), University of Toronto; Public Health Ontario (Wilson, Kus), Toronto, Ont.; Department of Family Medicine, School of Medicine (Karachiwalla), Queen’s University, Kingston, Ont.; Institute for Clinical Evaluative Studies, (Wilson), Toronto, Ont.
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Jeya Nadarajah
Public Health Branch (Cholewa, Karachiwalla), Regional Municipality of York, Newmarket, Ont.; Dalla Lana School of Public Health (Karachiwalla, Wilson), and Faculty of Medicine (Nadarajah), and Department of Laboratory Medicine and Pathobiology (Kus), University of Toronto; Public Health Ontario (Wilson, Kus), Toronto, Ont.; Department of Family Medicine, School of Medicine (Karachiwalla), Queen’s University, Kingston, Ont.; Institute for Clinical Evaluative Studies, (Wilson), Toronto, Ont.
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Julianne V. Kus
Public Health Branch (Cholewa, Karachiwalla), Regional Municipality of York, Newmarket, Ont.; Dalla Lana School of Public Health (Karachiwalla, Wilson), and Faculty of Medicine (Nadarajah), and Department of Laboratory Medicine and Pathobiology (Kus), University of Toronto; Public Health Ontario (Wilson, Kus), Toronto, Ont.; Department of Family Medicine, School of Medicine (Karachiwalla), Queen’s University, Kingston, Ont.; Institute for Clinical Evaluative Studies, (Wilson), Toronto, Ont.
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    Box 1: Roles and responsibilities for toxigenic diphtheria follow-up
    SectorRoles and responsibilities
    Health care (e.g., hospitals, community clinics)
    • Provide prompt diagnosis and treatment

    • Report promptly to local public health

    • Institute appropriate infection prevention and control measures

    • Support assessing close contacts (via collection of nasopharyngeal and throat swabs)

    • Support follow-up of any health care workers identified as close contacts who require contact management

    Public health (e.g., local, provincial, national)
    • Local public health:

      • Begin contact management immediately

      • Conduct local surveillance

      • Support collection of swabs and immunization of contacts

      • Lead community contact management

      • Lead community messaging, if required

    • Provincial public health (e.g., Ministry of Health, Public Health Ontario):

      • Coordinate access to diphtheria antitoxin

      • Provide advice or consultation to local public health

      • Conduct provincial disease surveillance

      • Coordinate notification to Public Health Agency of Canada, as needed

    • National public health (e.g., Public Health Agency of Canada):

      • Conduct national surveillance activities

      • Liaise with other national governments for contact tracing in home country, as needed

    Laboratory (e.g., front-line, provincial reference laboratory, National Microbiology Laboratory)
    • Front-line laboratories:

      • Process primary specimens and provide preliminary identification

    • Provincial reference microbiology laboratories:

      • Confirm identification, and if determined to be Corynebacterium diphtheriae, submit isolate to National Microbiology Laboratory

      • Process primary samples to culture specifically for C. diphtheriae when suspected (e.g., contacts of a case)

    • National Microbiology Laboratory:

      • Perform tox-gene polymerase chain reaction testing (PCR) to determine if isolate possesses the toxin gene; if tox PCR is positive, perform a modified Elek test to definitively show that the isolate produces diphtheria toxin

    • All levels: Provide advice regarding testing, turnaround times, interpretation

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Canadian Medical Association Journal: 193 (1)
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Vol. 193, Issue 1
4 Jan 2021
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Fatal respiratory diphtheria in a visitor to Canada
Scott Cholewa, Fareen Karachiwalla, Sarah E. Wilson, Jeya Nadarajah, Julianne V. Kus
CMAJ Jan 2021, 193 (1) E19-E22; DOI: 10.1503/cmaj.200707

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Fatal respiratory diphtheria in a visitor to Canada
Scott Cholewa, Fareen Karachiwalla, Sarah E. Wilson, Jeya Nadarajah, Julianne V. Kus
CMAJ Jan 2021, 193 (1) E19-E22; DOI: 10.1503/cmaj.200707
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